Clinical review: liberation from mechanical ventilation

Mohamad F El-Khatib, Pierre Bou-Khalil, Mohamad F El-Khatib, Pierre Bou-Khalil

Abstract

Mechanical ventilation is the defining event of intensive care unit (ICU) management. Although it is a life saving intervention in patients with acute respiratory failure and other disease entities, a major goal of critical care clinicians should be to liberate patients from mechanical ventilation as early as possible to avoid the multitude of complications and risks associated with prolonged unnecessary mechanical ventilation, including ventilator induced lung injury, ventilator associated pneumonia, increased length of ICU and hospital stay, and increased cost of care delivery. This review highlights the recent developments in assessing and testing for readiness of liberation from mechanical ventilation, the etiology of weaning failure, the value of weaning protocols, and a simple practical approach for liberation from mechanical ventilation.

Figures

Figure 1
Figure 1
Algorithm for liberation from mechanical ventilation. BP, blood pressure; CPAP, continuous positive airway pressure; FiO2, fraction of inspired oxygen; HR, heart rate; PaO2, partial pressure of arterial oxygen; PEEP, positive end expiratory pressure; PSV, pressure support ventilation; RR, respiration rate; RSBI, rapid shallow breathing index; SpO2, oxygen saturation.

References

    1. Hall JB, Wood LDH. Liberation of the patient from mechanical ventilation. JAMA. 1987;257:1621–1628. doi: 10.1001/jama.257.12.1621.
    1. Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, Gasparetto A, Lemaire F. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med. 1994;150:896–903.
    1. Esteban A, Furtos F, Tobin MJ, Alia I, Solsona JF, Vallverdu I, Fernandez R, de la Cal MA, Benito S, Tomas R, Carriedo D, Macias S, Blanco J. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med. 1995;332:345–350. doi: 10.1056/NEJM199502093320601.
    1. Esteban A, Alia I, Gordo F, Fernandez R, Solsona JF, Vallverdu I, Macia S, Allegue JM, Blanco J, Carriedo D, Leon M, de la Cal MA, Taboada F, Gonzalez de Velasco J, Palazon E, Carizosa F, Tomas R, Suarez J, Goldwasser RS. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1997;156:459–465.
    1. Esteban A, Alia I, Tobin MJ, Gil A, Gordo F, Vallverdu I, Blanch L, Bonet A, Vazquez A, de Pablo R, Torres A, de la Cal MA, Macias S. Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1999;159:512–518.
    1. Vallverdu I, Calaf N, Subirana M, Net A, Benitto S, Mancebo J. Clinical characteristics, respiratory functional parameters, and outcome of two-hour T-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med. 1998;158:1855–1862.
    1. Esteban A, Alia I, Ibanez J, Benito S, Tobin MJ. Modes of mechanical ventilation and weaning: a national survey of Spanish hospitals. The Spanish Lung Failure Collaborative Group. Chest. 1994;106:1188–1193. doi: 10.1378/chest.106.4.1188.
    1. Nevins ML, Epstein SK. Predictors of outcome for patients with COPD requiring invasive mechanical ventilation. Chest. 2001;119:1840–1845. doi: 10.1378/chest.119.6.1840.
    1. Stroetz RW, Hubmayr RD. Tidal volume maintenance during weaning with pressure support. Am J Respir Crit Care Med. 1995;152:1034–1040.
    1. Afessa B, Hogans L, Murphy R. Predicting 3-day and 7-day outcomes of weaning from mechanical ventilation. Chest. 1999;116:456–461. doi: 10.1378/chest.116.2.456.
    1. MacIntyre NR, Cook DJ, Ely EW, Jr, Epstein SK, Fink JB, Heffner JE, Hess D, Hubmayer RD, Scheinborn DJ. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College for Critical Care Medicine. Chest. 2001;120:375S–395S. doi: 10.1378/chest.120.6_suppl.375S.
    1. Conti G, Montini L, Pennisi MA, Cavaliere F, Arcangeli A, Bocci MG, Proietti R, Antonelli M. A prospective, blinded evaluation of indexes proposed to predict weaning from mechanical ventilation. Intensive Care Med. 2004;30:830–836. doi: 10.1007/s00134-004-2230-8.
    1. Epstein SK. Weaning parameters. Respir Care Clin N Am. 2000;6:253–301. doi: 10.1016/S1078-5337(05)70070-8.
    1. Meade M, Guyatt G, Sinuff T, Griffith L, Hand L, Toprani G, Cook D. Trials comparing alternative weaning modes and discontinuation assessments. Chest. 2001;120:425S–437S. doi: 10.1378/chest.120.6_suppl.425S.
    1. El-Khatib MF, Jamaleddine G, Khoury A, Obeid M. Effect of continuous positive airway pressure on the rapid shallow breathing index in patients following cardiac surgery. Chest. 2002;121:475–479. doi: 10.1378/chest.121.2.475.
    1. El-Khatib MF, Zeinelddine S, Jamaleddine G. The effect of pressure support ventilation and positive end expiratory pressure on the rapid shallow breathing index. Intensive Care Med. 2008;34:505–510. doi: 10.1007/s00134-007-0939-x.
    1. Sahn SA, Lakshminaraya S. Bedside criteria for discontinuation of mechanical ventilation. Chest. 1973;63:1002–1005. doi: 10.1378/chest.63.6.1002.
    1. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med. 1991;324:1445–1450.
    1. Chatila W, Jacob B, Guaglionone D, Manthous CA. The unassisted respiratory rate:tidal volume ratio accurately predicts weaning outcome. Am J Med. 1996;101:61–67. doi: 10.1016/S0002-9343(96)00064-2.
    1. Jacob B, Chatila W, Manthous CA. The unassisted respiratory rate/tidal volume ratio accurately predicts weaning outcome in post-operative patients. Crit Care Med. 1996;25:253–7. doi: 10.1097/00003246-199702000-00010.
    1. Martinez A, Seymour C, Nam M. Minute ventilation recovery time: a predictor of extubation outcome. Chest. 2003;123:1214–1221. doi: 10.1378/chest.123.4.1214.
    1. Trwit JD, Marini JJ. Validation of a technique to assess maximal inspiratory pressure in poorly cooperative patients. Chest. 1992;102:1216–1219. doi: 10.1378/chest.102.4.1216.
    1. Bruton A. A pilot study to investigate any relationship between sustained maximal inspiratory pressure and extubation outcome. Heart Lung. 2002;31:141–149. doi: 10.1067/mhl.2002.122840.
    1. Holliday JE, Hyers TM. The reduction of weaning time from mechanical ventilation using tidal volume and relaxation feedback. Am Rev Respir Dis. 1990;141:1214–1220.
    1. MacIntyre NR. Weaning from mechanical ventilatory support: volume-assisting intermittent breaths versus pressure-assisting every breaths. Respir Care. 1988;33:121–125.
    1. Engoren M. Approximate entropy of respiratory rate and tidal volume during weaning from mechanical ventilation. Crit Care Med. 1998;26:1817–1823.
    1. El-Khatib MF, Jamaleddine G, Soubra R, Muallem M. Pattern of spontaneous breathing: potential marker for weaning outcome. Spontaneous breathing pattern and weaning from mechanical ventilation. Intensive Care Med. 2001;27:52–58. doi: 10.1007/s001340000758.
    1. DeHaven CB, Kirton OC, Morgan JP, Hart AM, Shatz DV, Civetta JM. Breathing measurement reduces false-negative classification of tachypneic preextubation trial failures. Crit Care Med. 1996;24:976–980. doi: 10.1097/00003246-199606000-00017.
    1. Kacmarek RM. Point of view: pressure support. Respir Care. 1989;34:136–138.
    1. Tobin MJ, Perez W, Guenther SM, Semmes BJ, Mador MJ, Allen SJ, Lodato RF, Dantzker DR. The pattern of breathing during successful and unsuccessful trials of weaning from mechanical ventilation. Am Rev Respir Dev. 1986;134:1111–8.
    1. Nava S, Zanotti E, Rubini F. Weaning and outcome from mechanical ventilation. Monaldi Arch Chest Dis. 1994;49:530–532.
    1. Mergoni M, Costa A, Primavera S, Salvadori A, Saccani A, Zuccoli P. Assessment of various new predictive parameters of the outcome of mechanical ventilation weaning. Minerva Anestesiol. 1996;62:153–64.
    1. Vassilakopoulos T, Zakynthinos S, Roussos C. The tension-time index and the frequency/tidal volume ratio are the major pathophysiologic determinants of weaning failure and success. Am J Respir Crit Care Med. 1998;158:378–385.
    1. Vassilakopoulos T, Routsi C, Sotiropoulo C, Bitsakou C, Stanopoulos I, Roussos C, Zakynthinos S. The combination of the load/force balance and the frequency/tidal volume can predict weaning outcome. Intensive Care Med. 2006;32:684–691. doi: 10.1007/s00134-006-0104-y.
    1. Lee KH, Hui KP, Chan TB, Tan WC, Lim TK. Rapid shallow breathing (frequencytidal volume ratio) did not predict extubation outcome. Chest. 1994;105:540–543. doi: 10.1378/chest.105.2.540.
    1. Epstein SK. Evaluation of the rapid shallow breathing index in the clinical setting. Am J Respir Crit Care Med. 1995;152:545–549.
    1. Pierson DJ. Weaning from mechanical ventilation: why all the confusion? Resp Care. 1995;40:228–233.
    1. Krieger BP, Isber J, Breitenbucher A, Throop G, Ershowsky P. Serial measurements of the rapid-shallow breathing index as a predictor of weaning outcome in elderly medical patients. Chest. 1997;112:1029–1034. doi: 10.1378/chest.112.4.1029.
    1. Alvisi R, Volta CA, Righini ER, Capuzzo M, Ragazzi R, Verri M, Candini G, Gritti G, Milic-Emili J. Predictors of weaning outcome in chronic obstructive pulmonary disease patients. Eur Respir J. 2000;15:656–662. doi: 10.1034/j.1399-3003.2000.15d06.x.
    1. Tanios M, Nevins M, Hendra K, Cardinal P, Allan J, Naumova E, Epstein S. A randomized, controlled trial of the role of weaning predictors in clinical decision making. Crit Care Med. 2006;34:2530–2535. doi: 10.1097/01.CCM.0000236546.98861.25.
    1. Tobin MJ. Advances in mechanical ventilation. N Engl J Med. 2001;344:1986–1996. doi: 10.1056/NEJM200106283442606.
    1. Kuhlen R, Hausmann S, Pappert D, Slama K, Rossaint R, Falke K. A new method for P0.1 measurement using standard respiratory equipment. Intensive Care Med. 1995;21:554–560. doi: 10.1007/BF01700159.
    1. Capdevila XJ, Perrigault PF, Perey PJ, Roustan JP, d'Athis F. Occlusion pressure and its ratio to maximum inspiratory pressure are useful predictors for successful extubation following T-piece weaning trial. Chest. 1995;108:482–489. doi: 10.1378/chest.108.2.482.
    1. Hess D, Kacmarek R. Essentials of Mechanical Ventilation. 2. Columbus, OH: McGraw-Hill; 2002. Weaning from mechanical ventilation; pp. 121–135.
    1. Jones DP, Byrne P, Morgan C, Fraser I, Hyland R. Positive end-expiratory pressure versus T-piece; extubation after mechanical ventilation. Chest. 1991;100:1655–1659. doi: 10.1378/chest.100.6.1655.
    1. Wysocki M, Cracco C, Teixeira A, Mercat A, Diehl J-L, Lefort Y, Derenne J-P, Similowski T. Reduced breathing variability as a predictor of unsuccessful patient separation from mechanical ventilation. Crit Care Med. 2006;34:2076–2083. doi: 10.1097/01.CCM.0000227175.83575.E9.
    1. Perren A, Domenighetti G, Mauri S, Genini F, Vizzardi N. Protocol-directed weaning from mechanical ventilation: clinical outcome in patients randomized for a 30-min or 120-min trial with pressure support ventilation. Intensive Care Med. 2002;28:1058–1063. doi: 10.1007/s00134-002-1353-z.
    1. Vitacca M, Vianello A, Colombo D, Clini E, Porta R, Bianchi L, Arcaro G, Vitale G, Guffanti E, Lo Coco A, Ambrosino N. Comparison of two methods for weaning patients with chronic obstructive pulmonary disease requiring mechanical ventilation for more than 15 days. Am J Respir Crit Care Med. 2001;164:225–230.
    1. Banner MJ, Kirby RR, Blanch PB, Layon AJ. Decreasing imposed work of breathing apparatus to zero using pressure-support ventilation. Crit Care Med. 1993;21:1333–1338.
    1. Brochard L, Rua F, Lorino H, Lemaire F, Harf A. Inspiratory pressure support compensates for the additional work of breathing caused by the endotracheal tube. Anesthesiology. 1991;75:739–745. doi: 10.1097/00000542-199111000-00004.
    1. Wright PE, Marini JJ, Bernard GR. In vitro versus in vivo comparison of endotracheal tube airflow resistance. Am Rev Respir Dis. 1989;140:10–16.
    1. Ezingeard E, Diconne e, Guyomarc'h S, Venet C, Page D, Gery P, Vermsch R, Bertrand M, Pingat J, Tardy B, Bertrand JC, Zeni F. Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing. Intensive Care Med. 2006;32:165–169. doi: 10.1007/s00134-005-2852-5.
    1. Imsand C, Feihl F, Perret C, Fitting JW. Regulation of inspiratory neuromuscular output during synchronized intermittent mechanical ventilation. Anesthesiology. 1994;80:13–22. doi: 10.1097/00000542-199401000-00006.
    1. Marini JJ, Rodriguez RM, Lamb V. The inspiratory workload of patient-initiated mechanical ventilation. Am Rev Respir Dis. 1986;134:902–909.
    1. Leung P, Jubran A, Tobin MJ. Comparison of assisted ventilator modes on triggering, patient effort, and dyspnea. Am J Respir Crit Care Med. 1997;155:1940–8.
    1. Kuhlen R, Max M, Dembinski R, Terbeck S, Jurgens E, Rossaint R. Breathing pattern and workload during automatic tube compensation, pressure support and T-piece trials in weaning patients. Eur J Anaesthesiol. 2003;20:10–6. doi: 10.1017/S0265021503000024.
    1. Cohen J, Shapiro M, Grozovski E, Lev S, Fisher H, Singer P. Extubation outcome following a spontaneous breathing trial with automatic tube compensation versus continuous positive airway pressure. Crit Care Med. 2006;34:682–686. doi: 10.1097/01.CCM.0000201888.32663.6A.
    1. Georgopoulos D. Proprtional assist ventilation: an alternative approach to wean the patient. Eur J Anaesthesiol. 1998;15:756–760.
    1. Sinderby C, Beck J. Proportional assist ventilation and neurally adjusted ventilatory assist – better approaches to patient ventilator synchrony? Clin Chest Med. 2008;29:329–342. doi: 10.1016/j.ccm.2008.01.007.
    1. Del Rosario N, Sassoon CS, Chetty KG, Gruer SE, Mahutte CK. Breathing pattern during acute respiratory failure and recovery. Eur Respir J. 1997;10:2560–2565. doi: 10.1183/09031936.97.10112560.
    1. Kirton OC, DeHaven CB, Morgan JP, Windsor J, Civetta JM. Elevated imposed work of breathing masquerading as ventilator weaning intolerance. Chest. 1995;108:1021–1025. doi: 10.1378/chest.108.4.1021.
    1. Strauss C, Louis B, Isabey D, Lemaire F, Harf A, Brochard L. Contribution of the endotracheal tube and the upper airway to breathing workload. Am J Respir Crit Care Med. 1998;157:23–30.
    1. Manthous CA, Schmidt GA. Resistive pressure of a condenser humidifier in mechanically ventilated patients. Crit Care Med. 1994;22:1792–1795.
    1. Zanotti E, Rubini F, Iotti G, Braschi A, Palo A, Bruschi C, Fracchia C, Nava S. Elevated static compliance of the total respiratory system: early predictor of weaning unsuccess in several COPD patients mechanically ventilated. Intensive Care Med. 1995;21:399–405. doi: 10.1007/BF01707408.
    1. Murata K, Kubota T. Impairment of chest wall mechanics and increased chest wall work of breathing cause postoperative respiratory failure in patients who have undergone radical esophagotomy. J Anesth. 2001;15:125–131. doi: 10.1007/s005400170012.
    1. Tassaux D, Gainnier M, Battisti A, Jolliet P. Helium-oxygen decreases inspiratory effort and work of breathing during pressure support in intubated patients with chronic obstructive pulmonary disease. Intensive Care Med. 2005;31:1501–1507. doi: 10.1007/s00134-005-2796-9.
    1. Ranieri VM, Mascia L, Petruzzelli V, Bruno F, Guiliani R. Inspiratory effort and measurement of dynamic intrinsic PEEP in COPD patients: effects of ventilator triggering systems. Intensive Care Med. 1995;21:896–903. doi: 10.1007/BF01712330.
    1. Reddy VG. Auto-PEEP: how to detect and how to prevent. Middle East J Anesthesiol. 2005;18:293–312.
    1. Jubran A, Mathru M, Dries D, Tobin MJ. Continuous recordings of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof. Am J Respir Crit Care Med. 1998;158:1763–1769.
    1. Marcellino R, Fernandes AP, Marum S, Ribeiro JP. The influence of cardiac diastole on weaning from mechanical ventilation. Rev Port Cardiol. 2002;21:849–857.
    1. Grasso S, Leone A, De Michele M, Anaclerio R, cafarelli A, Ancona G, Stripoli T, Bruno F, Pugliese P, Dambrosio M, Dalfino L, Di Serio F, Fiore T. Use of N-terminal pro-brain natriuretic peptide to detect acute cardiac dysfunction during weaning failure in difficult-to-wean patients with chronic obstructive pulmonary disease. Crit Care Med. 2007;35:96–105. doi: 10.1097/01.CCM.0000250391.89780.64.
    1. Frazier SK, Brom H, Widener J, Pender L, Stone KS, Moser DK. Prevalence of myocardial ischemia during mechanical ventilation and weaning and its effects on weaning success. Heart Lung. 2006;35:363–373. doi: 10.1016/j.hrtlng.2005.12.006.
    1. Srivastava S, Chatila W, Amoateng-Adjepong Y, Kanagasegar S, Jacob B, Zarich S, Manthous CA. Myocardial ischemia and weaning failure in patients with coronary artery disease: an update. Crit Care Med. 1999;27:2109–2112. doi: 10.1097/00003246-199910000-00005.
    1. Vieira JM, Jr, Castro I, Curvello-Neto A, Demarzo S, Caruso P, Pastore L, Jr, Imanishe MH, Abdulakader RC, Deheinzelin D. Effect of acute kidney injury on weaning from mechanical ventilation in critically ill patients. Crit Care Med. 2007;35:184–191. doi: 10.1097/01.CCM.0000249828.81705.65.
    1. Behnia M, Clay AS, Farber MO. Management of myxedematous respiratory failure: review of ventilation and weaning principles. Am J Med Sci. 2000;320:368–373. doi: 10.1097/00000441-200012000-00003.
    1. Huang CJ, Lin HC. Association between adrenal insufficiency and ventilator weaning. Am J Respir Crit Care Med. 2006;173:276–280. doi: 10.1164/rccm.200504-545OC.
    1. Frutos-Vivar F, Esteban A. Critical illness polyneuropathy: a new (or old?) reason for weaning failure. Crit Care Med. 2005;33:452–453. doi: 10.1097/01.CCM.0000153525.37281.D4.
    1. Garnacho-Montero J, Amaya-Villar R, Garcia-Garmendia J, Madrazo-Osuna J, Ortiz-Leyba C. Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit Care Med. 2005;33:349–354. doi: 10.1097/01.CCM.0000153521.41848.7E.
    1. Reid C. Frequency of under- and overfeeding in mechanically ventilated ICU patients: causes and possible consequences. J Hum Nutr Diet. 2006;19:13–22. doi: 10.1111/j.1365-277X.2006.00661.x.
    1. Pierson DJ. Nonrespiratory aspects of weaning from mechanical ventilation. Resp Care. 1995;40:263–271.
    1. Cook D, Meade M, Guyatt G, Butler R, Aldawood A, Epstein S. Trials of miscellaneous interventions to wean from mechanical ventilation. Chest. 2001;120:438S–444S. doi: 10.1378/chest.120.6_suppl.438S.
    1. Martensson IE, Fridlund B. Factors influencing the patient during weaning from mechanical ventilation: a national survey. Intensive Crit Care Nurs. 2002;18:219–229. doi: 10.1016/S0964339702000630.
    1. Thomas LA. Clinical management of stressors perceived by patients on mechanical ventilation. AACN Clin Issues. 2003;14:73–81.
    1. Nelson JE, Meier DE, Litke A, Natale DA, Siegel RE, Moeeison RS. The symptom burden of chronic critical illness. Crit Care Med. 2004;32:1527–1534. doi: 10.1097/01.CCM.0000129485.08835.5A.
    1. Girard T, Kress J, Fuchs B, Thomason J, Schweickert W, Pun B, Taichman D, Dunn J, Pohlman A, Kinniry P, Jackson J, Canonico A, Light R, Shintani A, Thompson J, Gordon S, Hall J, Dittus R, Bernard G, Ely EW. Efficacy and safety of paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (awakening and breathing Controlled trial): a randomized controlled trial. Lancet. 2008;371:126–134. doi: 10.1016/S0140-6736(08)60105-1.
    1. Polese G, Massara A, Poggi R, Brandolese R, Brandi G, Rossi A. Flow-triggering reduces inspiratory effort during weaning from mechanical ventilation. Intensive Care Med. 1995;21:682–686. doi: 10.1007/BF01711550.
    1. Racca F, Squadrone V, Ranieri VM. Patient-ventilator interaction during the triggering phase. Respir Care Clin N Am. 2005;11:225–245. doi: 10.1016/j.rcc.2005.01.001.
    1. Shneerson JM. Are there new solutions to old problems with weaning. Br J Anaesth. 1997;78:238–240.
    1. Ely EW. The utility of weaning protocols to expedite liberation from mechanical ventilation. Respir Care Clin N Am. 2000;6:303–19. doi: 10.1016/S1078-5337(05)70071-X.
    1. McLean SE, Jensen LA, Schroeder DG, Gibney NR, Skjodt NM. Improving adherence to a mechanical ventilation weaning protocol for critically ill adults: outcomes after implementation program. Am J Crit Care. 2006;15:299–309.
    1. Hendrix H, Kaiser ME, Yusen RD, Merk J. A randomized trial of automated versus conventional protocol-driven weaning from mechanical ventilation following coronary artery bypass surgery. Eur J Cardiothorac Surg. 2006;29:957–963. doi: 10.1016/j.ejcts.2006.01.036.
    1. Gutierrez CJ, Harrow J, Haines F. Using an evidence-based protocol to guide rehabilitation and weaning of ventilator-dependent cervical spinal cord injury patients. J Rehabil Res Dev. 2003;40:99–110.
    1. Ramachandran V, Jo Grap M, Sessler C. Protocol-directed weaning: a process of continuous performance improvement. Crit Care. 2005;9:138–140. doi: 10.1186/cc3053.
    1. Hill NS. Following protocol: weaning difficult-to-wean patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;164:186–187.
    1. Marelich GP, Murin S, Battistella F, Inciardi J, Vierra T, Roby M. Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia. Chest. 2000;118:459–467. doi: 10.1378/chest.118.2.459.
    1. Dries DJ, McGonigal MD, Malian MS, Bor BJ, Sullivan C. Protocol-driven ventilator weaning reduces use of mechanical ventilation, rate of early reintubation, and ventilator-associated pneumonia. J Trauma. 2004;56:943–951.
    1. Iregui M, Ward S, Clinikscale D, Clayton D, Kollef MH. Use of handheld computer by respiratory care practitioners to improve the efficiency of weaning patients from mechanical ventilation. Crit Care Med. 2002;30:2038–2043. doi: 10.1097/00003246-200209000-00014.
    1. Lellouche F, Mancebo J, Jolliet P, Roeseler J, Schortgen F, Dojat M, Cabello B, Bouadma L, Rodriguez P, Maggiore S, Reynaert M, Mersmann S, Brochard L. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med. 2006;174:849–851. doi: 10.1164/rccm.200511-1780OC.
    1. Petter AH, Chiolro RL, Cassina T, Chassot PG, Muller XM, Revelly JP. Automatic "respiratory/weaning" with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management. Anesth Analg. 2003;97:1743–1750. doi: 10.1213/.
    1. Duane T, Riblet J, Golay D, Cole F, Weireter L, Britt L. Protocol-driven ventilator management in trauma intensive care unit population. Arch Surg. 2002;137:1223–1227. doi: 10.1001/archsurg.137.11.1223.
    1. Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, Johnson MM, Browder RW, Bowton DL, Haponik EH. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996;335:1864–1869. doi: 10.1056/NEJM199612193352502.
    1. Grap MJ, Strickland D, Tormey L, Keane K, Lubin S, Emerson J, Winfield S, Townes R, Sessler CN. Collaborative practice: development, implementation, and evaluation of weaning protocol for patients receiving mechanical ventilation. Am J Crit Care. 2003;12:454–460.
    1. Kollef MH, Shapiro SD, Silver P, St John RE, Prentice D, Sauer S, Ahrens TS, Shannon W, Baker-Clinkscale D. A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med. 1997;25:567–574. doi: 10.1097/00003246-199704000-00004.
    1. Blackwood B, Wilson-Barnett J, Trinder J. Protocolized weaning from mechanical ventilation: ICU physicians' views. J Adv Nurs. 2004;48:26–34. doi: 10.1111/j.1365-2648.2004.03165.x.
    1. Blackwood B, Wilson-Barnett J, Patterson CC, Trinder TJ, Lavery GG. An evaluation of protocolised weaning on the duration of mechanical ventilation. Anaesthesia. 2006;61:1079–1086. doi: 10.1111/j.1365-2044.2006.04830.x.
    1. Tonnelier JM, Prat G, Le Gal G, Gut-Gobert C, Renault A, Boles JM, L'Her E. Impact of a nurses' protocol-directed weaning procedure on outcomes in patients undergoing mechanical ventilation for longer than 48 hours: a prospective cohort study with a matched historical control group. Crit Care. 2005;9:R83–R89. doi: 10.1186/cc3030.
    1. Goodman S. Implementing a protocol for weaning patients off mechanical ventilation. Nurs Crit Care. 2006;11:23–32.
    1. Ferrer M, Esquinas A, Aranciba F, Thomas-Bauer T, Gonzalez G, Carrillo A, Rodriguez-Roisin R, Torres A. Noninvasive ventilation during persistent weaning failure. Am J Respir Crit Care Med. 2003;168:70–76. doi: 10.1164/rccm.200209-1074OC.
    1. Nava S, Ambrossino N, Clini E, Prato M, Orlando G, Vitacca M, Brigada P, Fracchia C, Rubini F. Noninvasive mechanical ventilation in the weaning of patients with respiration failure due to chronic obstructive pulmonary disease: a randomized, controlled trial. Ann Intern Med. 1998;128:721–728.
    1. Burns KE, Adhikari NK, Meade MO. A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation. Can J Anaesth. 2006;53:305–315.
    1. Esteban A, Frutos-Vivar F, Ferguson N, Arabi Y, Apezteguia C, Gonzales M, Epstein S, Hill N, Nava S, Soares M-A, D'Empaire G, Alia I, Anzueto A. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med. 2004;350:2452–2460. doi: 10.1056/NEJMoa032736.
    1. Esteban A, Alia I, Gordo F, Fernandez R, Solsona J, Vallverdu I, Macias S, Allegue J, Blanco J, carriedo D, Leon M, de La Cal M, Taboada F, Gonzalea de Velasco J, Palazon E, Carrizosa F, Tomas R, Suarez J, Goldwasser R. Extubation outcome after spontaneous breathing trials with T-piece or pressure support ventilation: the Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1997;156:459–465.
    1. Esteban A, Alia I, Tobin M, Gil A, Gordo F, Vallverdu I, Blanch L, Bonet A, Vazquez A, de Pablo R, Torres A, de La Cal M, Macias S. Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation: Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1999;159:512–518.
    1. Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous C. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest. 2001;120:1262–1270. doi: 10.1378/chest.120.4.1262.
    1. Salam A, Tilluckdharry L, Amoateng-Adjepong Y, Manthous C. Neurologic status, cough, secretions and extubation outcomes. Intensive Care Med. 2004;30:1334–1339. doi: 10.1007/s00134-004-2231-7.
    1. Francois B, Bellissant E, Gissot V, Desachy A, Sandrine N, Boulain T, Brenet O, Preux P-M, Vignon P. 12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema: a randomized double-blind trial. Lancet. 2007;369:1083–1089. doi: 10.1016/S0140-6736(07)60526-1.
    1. Pierson DJ. Tracheostomy and weaning. Respir Care. 2005;50:526–533.
    1. Hsu CL, Chen KY, Chang CH, Jerng JS, Yu CJ, Yang PC. Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study. Crit Care. 2005;9:R46–R52. doi: 10.1186/cc3018.
    1. Boynton JH, Hawkins K, Eastridge BJ, O'Keefe GE. Tracheostomy timing and the duration of weaning in patients with acute respiratory failure. Crit Care. 2004;8:R261–R267. doi: 10.1186/cc2885.
    1. Diehl JL, El Atrous S, Trouchard D, Lemaire F, Brochard L. Changes in the work of breathing induced by tracheostomy in ventilator-dependent patients. Am J Respir Crit Care Med. 1999;159:383–388.
    1. Davis K, Jr, Campbell RS, Johannigman JA, Valente JF, Branson RD. Changes in respiratory mechanics after tracheostomy. Arch Surg. 1999;134:59–62. doi: 10.1001/archsurg.134.1.59.
    1. Grinnan D, Truwit J. Clinical review: respiratory mechanics in spontaneous and assisted ventilation. Crit Care. 2005;9:472–484. doi: 10.1186/cc3516.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel